Editorial: Compelling reasons to expand Medicaid

State Sen. Brian Kelsey's proposed bill to block expansion of Tennessee's Medicaid program is premature.

The Germantown Republican and the bill's co-sponsors should give Gov. Bill Haslam a chance, as Haslam said in his budget address Monday, "to gather all of the information possible to understand the impact on our budget, the impact on community hospitals, the impact on health care in Tennessee, and the impact on our citizens. This decision is too important not to do that."

Kelsey's bill, labeled the TennCare Fiscal Responsibility Act, would prevent expansion of the state's Medicaid program under the provisions of the Affordable Care Act, better known as Obamacare.

Two key concerns of expansion opponents and governors like Haslam, who still are weighing a decision, are the cost of adding more people to Medicaid rolls and skepticism about whether the federal government will honor its commitment to cover most of the cost of expansion over the long term.

Medicaid is funded by federal and state governments, and pays the medical expenses of people who cannot afford health insurance. It comprises roughly 30 percent of the state budget.

The U.S. Supreme Court upheld the ACA, which was pushed by President Barack Obama as a means toward improving the health care system and increasing access to health care coverage for Americans. The high court, however, ruled that the federal government could not force states to expand their Medicaid programs.

For states that decide to expand, the federal government will pay 100 percent of the costs for three years, beginning next year. The government would phase down its share of the cost to 90 percent by 2020, with states paying the rest. Tennessee's estimated 10 percent share would be about $200 million, which Kelsey and some of his fellow Republican lawmakers maintain the state cannot afford. The real question, though, is whether the state can afford not to expand the program.

The working poor, who will not be able to buy health insurance, will continue to turn up in emergency rooms because they don't have a primary care physician. That is uncompensated care hospitals like the Regional Medical Center at Memphis have to absorb, and care taxpayers end up subsidizing.

Rural hospitals could be hit particularly hard because the Disproportionate Share Hospital subsidies would possibly decline unless Medicaid is expanded. Also, not expanding the program could kill an estimated 7,500 jobs the expansion is expected to generate next year.

Taken as a whole, those factors give the Republican governor some political cover from members of his party who don't want to support anything that has Obama's fingerprints.

Haslam cannot be blamed for being fiscally cautious on an issue that is so important to the state. Still, despite the added costs of expansion, these are compelling reasons to move forward.

In his budget address, Haslam said the state needed to talk about the health of its citizens and how to promote healthy lifestyles. One way to do that is to make sure all citizens have access to primary health care, which helps people remain healthier and prevents some illnesses from becoming expensive, critical-care maladies.

And the fiscal concerns about expanding Medicaid should not be resolved on the backs of the state's poor.